Consultation Request: Date (3 years ago)
Evaluate nutritional status of 69 yo female with metastatic breast cancer (bone).
Selected for experimental chemotherapy starting today.
Dr Luickas
NUTRITION PROGRESS NOTE Date: (3 years ago)
Assessment
Food and Nutrition History:
Patient dietary recall indicates adequate diet, with all food groups included in adequate amounts (2-3 dairy, 2-3 protein/meat servings, 4-6 fruits and vegetables, and 4-6 grain servings).
Patient states understanding of the importance of nutrition and is proud of her success in reducing sweets and including more fruits and vegetables.
Patient states there are no nutritional issues and does not want a follow-up at this time.
Physical activity includes household chores in three-story house, gardening, walking 2-3 x/ week.
Anthropometric
Ht: 155 cm (5’1”)
Wt: 78.5 kg (173 lb)
BMI: 32.77
Weight History
Highest weight 83.9 kg (185 lbs) approx. 25 years ago
Weight stable for last 5 years
Biochemical, Medical tests and Procedures:
Glucose, albumin, lipid panel and electrolytes all within normal ranges
Client History:
69 yo female, lives alone in community about 480 km (298 miles) away, a retired nurse
Breast cancer first diagnosed when patient was 53 yo.
Remission established at age 56
Recurrence-metasized to bones
Nutrition Diagnosis
Predicted inadequate energy intake related to the initiation of chemotherapy as evidenced by research indicating chemotherapy often reduces energy and protein intake due to nausea.
(NOTE: Patient meets criteria for overweight, however with cancer treatment ahead, weight reduction is not indicated at this time.)
OR
Predicted excessive energy intake related to initiation of chemotherapy as evidenced by documented unintended weight change: 2.26-11.34 kg (5-25 lbs weight gain)
(NOTE: Patient meets criteria for overweight, however with cancer treatment ahead, weight reduction is not indicated at this time.)
Nutrition Intervention
Nutrition Prescription:
Diet emphasizing intake of whole grains, fruits and vegetables with low glycemic indices and protein from fish, dairy/ alternatives and plants
Adequate fiber and fluid
Nutrition Counselling
Health Belief Model: Relapse prevention
Over time the patient had been successful and then in other times, she has resumed some of her older habits with high sugar and dessert intake. Reinforced the importance of maintaining her current healthy diet rich in whole grains, protein and fresh fruits and vegetables to maintain adequate nutrition status during chemotherapy. Evaluated how current recurrence of cancer may impact her dietary intake and what other situations may lead to choosing less healthy food options.
Nutrition Monitoring and Evaluation
Changes in the following parameters would indicate a need for a follow-up appointment with dietitian. Lillie will monitor the following and make appointment with dietitian if the following occur:
- Food and Nutrition History - Nutrition Related Activities of Daily Living - Significant changes in ability to accomplish daily living activities (e.g. loss of strength)
- Anthropometric Measures - Significant weight loss or weight gain
- Weight change amounting to more than 4 lbs per month would trigger a re-evaluation
- Nutrition Focused Physical Examination – Digestive System
- Decrease in appetite (for more than several days)
- Persistent gastrointestinal symptoms nausea, vomiting, excess thirst or constipation
Will address overweight if weight increases or it becomes appropriate to initiate weight reduction to a more healthy weight.